Why the study?
In pulmonary arterial hypertension, right ventricular adaptive mechanisms eventually fail, prompting the need for a multimodal approach to estimate the prognostic value of RV coupling parameters.
Does multimodal assessment of RV-arterial coupling predict death or clinical deterioration in patients with stable PAH?
Does multimodal assessment of RV-arterial coupling predict death or clinical deterioration in patients with stable PAH?
Combining CMR-derived RV global longitudinal strain with hemodynamic measurements provides significant prognostic value for predicting death or clinical deterioration in patients with pulmonary arterial hypertension.
May support multimodal RV coupling assessment in PAH; leaves open validation for prognostication.
In pulmonary arterial hypertension (PAH) increased afterload leads to adaptive processes of the right ventricle (RV) that help to maintain arterio-ventricular coupling of RV and preserve cardiac output, but with time the adaptive mechanisms fail. In this study, we propose a multimodal approach which allows to estimate prognostic value of RV coupling parameters in PAH patients. Twenty-seven stable PAH patients (49.5 ± 15.5 years) and 12 controls underwent cardiovascular magnetic resonance (CMR). CMR feature tracking analysis was performed for RV global longitudinal strain assessment (RV GLS). RV-arterial coupling was evaluated by combination of RV GLS and three proposed surrogates of RV afterload—pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR) and pulmonary artery compliance (PAC). 18-FDG positron emission tomography (PET) analysis was used to assess RV glucose uptake presented as SUV RV/LV . Follow-up time of this study was 25 months and the clinical end-point was defined as death or clinical deterioration. Coupling parameters (RV GLS/PASP, RV GLS/PVR and RV GLS*PAC) significantly correlated with RV function and standardized uptake value (SUV RV/LV ). Patients who experienced a clinical end-point (n = 18) had a significantly worse coupling parameters at the baseline visit. RV GLS/PASP had the highest area under curve in predicting a clinical end-point and patients with a value higher than (−)0.29%/mmHg had significantly worse prognosis. It was also a statistically significant predictor of clinical end-point in multivariate analysis (adjusted R 2 = 0.68; p < 0.001). Coupling parameters are linked with RV hemodynamics and glucose metabolism in PAH. Combining CMR and hemodynamic measurements offers more comprehensive assessment of RV function required for prognostication of PAH patients. Trial Registration : NCT03688698, 09/26/2018, retrospectively registered; Protocol ID: 2017/25/N/NZ5/02689
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Kazimierczyk et al. (2021) studied this question.
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